Background. We conducted a comparative effectiveness analysis to evaluate the difference in the amount of physical activity children engaged in when enrolled in a physical activity-enhanced after-school program based in a community recreation center versus a standard school-based after-school program. Methods. The study was a natural experiment with 54 elementary school children attending the community ASP and 37 attending the school-based ASP. Accelerometry was used to measure physical activity. Data were collected at baseline, 6 weeks, and 12 weeks, with 91% retention. Results. At baseline, 43% of the multiethnic sample was overweight/obese, and the mean age was 7.9 years (SD = 1.7). Linear latent growth models suggested that the average difference between the two groups of children at Week 12 was 14.7 percentage points in moderate-vigorous physical activity ( ). Cost analysis suggested that children attending traditional school-based ASPs—at an average cost of $17.67 per day—would need an additional daily investment of $1.59 per child for 12 weeks to increase their moderate-vigorous physical activity by a model-implied 14.7 percentage points. Conclusions. A low-cost, alternative after-school program featuring adult-led physical activities in a community recreation center was associated with increased physical activity compared to standard-of-care school-based after-school program. 1. Introduction Childhood obesity remains one of the most serious threats to the public’s health, with 1 in 3 children and adolescents overweight or obese (body mass index (BMI) ≥ 85th percentile) [1]. Childhood obesity is particularly problematic because it is resistant to treatment once established [2]. Accordingly, public health authorities are focusing on prevention. There is limited evidence for effective behavioral prevention interventions [3]. To fill this gap, the Institute of Medicine [4], the Strategic Plan for NIH Obesity Research [5], Shaping America’s Youth [6], and the White House Task Force on Childhood Obesity [7] have called for community-engaged, family-centered approaches to pediatric obesity prevention. These approaches are thought to have the greatest potential for sustained efforts and effects in our obesogenic environment. In parallel, comparative effectiveness research is being discussed within the national health reform debate as a mechanism for improving healthcare quality and decreasing healthcare spending [8]. Clinical research typically examines the effectiveness of one prevention or treatment method at a time. Comparative effectiveness research
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